ABSTRACT
INTRODUCTION: There is an increase in degenerative arthropathies because of the increase in the longevity of world's population, making primary knee arthroplasties a procedure to recover quality of life without pain. There are factors associated with the length of hospital stay after this procedure. OBJECTIVE: To determine the risk factors influencing the hospital stay during the postoperative period of patients undergoing primary total knee arthroplasty with an enhanced recovery after surgery protocol (ERAS). METHODS: A retrospective study is carried out on patients undergoing primary total knee arthroplasty at an University Hospital in the period 2017-2020 using the ERAS protocol, during which 957 surgeries were performed. RESULTS: Average age of 71.7±8.2years, 62.4% were women and the 77.3% were classified as ASAII. The significantly associated factors to an increased length of stay are: age (P=.001), ASA scale (P=.04), day of surgery (P<.001), blood transfusion (P<.001), postoperative hemoglobin level at 48-72h (P<.001), the time of first postoperative mobilization to ambulate and climb stairs (P<.001), the need for analgesic rescues (P=.003), and the presence of postoperative nausea and vomiting (P=.008). CONCLUSIONS: There are statistically significant and clinically relevant factors associated with hospital stay. Determining these factors constitutes an advantage in hospital management, in the development of strategies to improve and optimize the quality of care and available health resources.
ABSTRACT
Objetivo: Valorar si un programa de atención farmacéutica integrada (PAFI) en pacientes crónicos mejora la evolución clínica, la calidad de vida de los pacientes y disminuye el consumo de recursos sanitarios. Material y métodos Ensayo clínico, paralelo, abierto y multicéntrico de un PAFI en pacientes con insuficiencia cardiaca (IC) y/o enfermedad pulmonar obstructiva crónica (EPOC) en 8 áreas de salud de Cataluña. Al paciente en intervención le realizaban seguimiento farmacoterapéutico los farmacéuticos de hospital, atención primaria y farmacia comunitaria. Al control, seguimiento habitual. Todos los pacientes fueron seguidos 12 meses y se les realizó un test de calidad de vida al inicio y final del seguimiento. Resultados Participaron 8 hospitales, 8 centros de atención primaria y 109 farmacias comunitarias. Finalizaron el estudio 238 pacientes con un porcentaje de pérdidas del 2,9%. No hubo diferencias significativas en reingresos, visitas al médico o urgencias. Se detectaron 50 problemas relacionados con medicamentos (PRM) en 37 pacientes, siendo estadísticamente significativa la diferencia de PRM entre el grupo intervención y control en pacientes con IC y casi significativa en pacientes con EPOC. El 36% de los PRM fueron moderados-graves. El 94% PRM fueron evitables y el farmacéutico los resolvió en el 90% de los casos. No hubo diferencias entre la calidad de vida al inicio y final del estudio ni en el consumo de recursos sanitarios. Conclusiones Los programas de atención farmacéutica integrada permiten la mejora de la calidad asistencial al paciente, no obstante es necesaria la utilización de registros electrónicos que faciliten la comunicación entre niveles asistenciales (AU)
Objectives: To assess whether an integrated pharmaceutical care programme (IPCP) improvesclinical evolution, patient quality of life, and reduces health costs in chronic patients. Material and methods: A parallel, open, and multi-centre clinical trial of an IPCP in patients with heart failure (HF) and/or chronic obstructive pulmonary disease (COPD) in 8 different health areas in Cataluña. The intervened patient was monitored for pharmacotherapeutic evolution by hospital pharmacists, primary care physicians, and community pharmacists. Controls received normal follow-up. All patients were monitored for 12 months, with quality of life tests administered at the beginning and end of follow-up. Results: We had the participation of 8 different hospitals, 8 primary care centres, and109 community pharmacies. 238 patients completed the study, with 2.9% of participants lost during the study period. There were no significant differences in terms of readmissions, visits to the doctors, or to emergency services. We detected 50 different medication-related problems(MRP) in 37 patients, with a statistically significant difference in terms of MRP between the control and treatment groups of patients with HF, and almost significant differences in COPD patients. MRP were moderate-severe in 36% of cases. MRP were avoidable in 94% of cases, and the pharmacist resolved the issue in 90% of cases. There were no differences in terms of patient quality of life or health costs between the start and end of the study. Conclusions: Integrated pharmaceutical care programs facilitate an improvement in the quality of patient care, but electronic registries are necessary to promote communication between sections of the health care network (AU)
Subject(s)
Humans , Chronic Disease/drug therapy , Polypharmacy , Pharmaceutical Services , Electronic Prescribing , Continuity of Patient Care/organization & administration , Drug Therapy, Computer-Assisted/methodsABSTRACT
OBJECTIVES: To assess whether an integrated pharmaceutical care programme (IPCP) improves clinical evolution, patient quality of life, and reduces health costs in chronic patients. MATERIAL AND METHODS: A parallel, open, and multi-centre clinical trial of an IPCP in patients with heart failure (HF) and/or chronic obstructive pulmonary disease (COPD) in 8 different health areas in Cataluña. The intervened patient was monitored for pharmacotherapeutic evolution by hospital pharmacists, primary care physicians, and community pharmacists. Controls received normal follow-up. All patients were monitored for 12 months, with quality of life tests administered at the beginning and end of follow-up. RESULTS: We had the participation of 8 different hospitals, 8 primary care centres, and 109 community pharmacies. 238 patients completed the study, with 2.9% of participants lost during the study period. There were no significant differences in terms of readmissions, visits to the doctors, or to emergency services. We detected 50 different medication-related problems (MRP) in 37 patients, with a statistically significant difference in terms of MRP between the control and treatment groups of patients with HF, and almost significant differences in COPD patients. MRP were moderate-severe in 36% of cases. MRP were avoidable in 94% of cases, and the pharmacist resolved the issue in 90% of cases. There were no differences in terms of patient quality of life or health costs between the start and end of the study. CONCLUSIONS: Integrated pharmaceutical care programs facilitate an improvement in the quality of patient care, but electronic registries are necessary to promote communication between sections of the health care network.
Subject(s)
Chronic Disease/drug therapy , Pharmaceutical Services/organization & administration , Aged , Aged, 80 and over , Chronic Disease/economics , Chronic Disease/psychology , Drug-Related Side Effects and Adverse Reactions , Female , Health Care Costs , Heart Failure/drug therapy , Humans , Interdisciplinary Communication , Male , Medical Errors/statistics & numerical data , Middle Aged , Pharmaceutical Services/economics , Pharmacists , Pulmonary Disease, Chronic Obstructive/drug therapy , Quality of Health Care , Quality of Life , SpainABSTRACT
Until the discovery of activated protein C resistance (APCR), less than 10% of patients with venous thromboembolism (VT) showed defects in proteins involved in the inhibition of coagulation. APCR is caused by a single point mutation in the factor V gene, and it is accepted that APCR is associated with an increased risk for VT. In this work, we studied the prevalence of APCR in venous thromboembolic patients and found it to be 10.5% compared with 4.5% in controls (p = 0.105).
Subject(s)
Drug Resistance/genetics , Protein C/genetics , Protein C/physiology , Thromboembolism/blood , Thromboembolism/epidemiology , Aged , Female , Humans , Male , Middle Aged , Phenotype , Prevalence , Prospective StudiesABSTRACT
PURPOSE: The purpose of this study is to demonstrate that flow cytometric measurement of DNA content and cell proliferation is useful and provides significant information about the diagnosis and prognosis of non Hodgkin lymphoma. PATIENTS AND METHODS: Clinical and histologic information of 66 lymphoma patients was registered at diagnosis. Fifty thick sections of lymphoma samples and 67 control samples were deparaffined, rehydrated, dissected and DNA stained using a modification of the method described by Hedley. We have studied the relationship between flow cytometric results and clinical, histologic, treatment outcome and prognosis of lymphoma. RESULTS AND CONCLUSIONS: No DNA aneuploid histograms were obtained from the control non neoplastic, lymphoid samples. Side scatter light values were significantly larger in high grade lymphomas. DNA content didn't show any correlation with clinical presentation and evolution of lymphoma, however, DNA aneuploidy was more frequent in high grade lymphomas (p = 0.0172), and in these patients, aneuploidy was related to with a lower percentage of complete remission achievement (p = 0.0248). A high S phase was associated with shorter survival in patients without remission post-treatment (p < 0.0001) and in low grade lymphomas (p = 0.0174). In conclusion, our data suggest that DNA flow cytometric study provides useful information for the diagnosis of lymphoma and identifies different prognostic groups of patients.
Subject(s)
Cell Cycle/genetics , DNA, Neoplasm/analysis , Lymphoma, Non-Hodgkin/genetics , Aneuploidy , Disease-Free Survival , Flow Cytometry , Humans , Lymphoma, Non-Hodgkin/pathology , PrognosisABSTRACT
An extensive summary on the results of treatment of diabetic patients with necessity of urgent treatment for ischemic or infectious complications is presented. Such frequent events often need an active treatment for infection, followed in some cases by a large debridement or minor amputations. Adequate treatment may avoid a major amputation. Revascularization surgery may play a opportune role and it depends on clinical criterion.
